The goals of this proposal are: (1) to develop an extensive multi-payor database that captures a significant proportion of the activities of dental service providers in various areas of the U.S. over time and (2) to address a number of specific issues related to the delivery and financing of dental care. Unique features of the proposed database include access to real-time, provider-specific and practice-specific information on factors associated with variation in services provided to different types of patients (e.g., level/types of third-party coverage, patient characteristics, patterns of utilization), the ability to obtain patient-specific data over periods of time (initially up to five years) that will allow for meaningful evaluations of the effects of numerous types and patterns of treatment, and the relatively low cost of data acquisition. Specific aims of this proposal are: (1) to develop a multipayor database derived from electronically-transmitted claims submitted by hundreds of provider systems to for-profit and not-for-profit third-party payors; (2) to examine the extent of variation in charges submitted by individual providers and practices for the same types of procedures to different payors; (3) to explore provider treatment behaviors and associated costs by examining variation in the use of alternative restorative procedures; and (4) to evaluate diagnostic radiograph usage to assess the extent, diagnostic yield and cost implications of variations in practice patterns, and to evaluate compliance with recommended usage guidelines. In spite of recognized limitations, the proposed database embodies several advantages that should facilitate analyses of patients, providers and payors cross-sectionally and over time that heretofore have been problematic due to the unique nature of the systems by which dental services are financed and delivered in the United States.